AAP: Abortion Parental Consent Laws Do More Harm than Good

Patient's right to confidential care should come first

Mandatory parental consent laws for abortion may cause medical and psychological harm to the pregnant adolescent, who should have the right to confidential care, the American Academy of Pediatrics declared in an official statement.

These laws, which were intended to enhance family communication and parental responsibility, instead increase the likelihood of a variety of harms to the adolescent by delaying her access to timely medical care, according to the AAP's Committee on Adolescence, writing in Pediatrics.

"No studies show that forced disclosure results in improved parent-child relationships, improved communication or improved satisfaction with the decision about the pregnancy outcome," argued the authors, who were led by committee chairperson Paula K. Braverman, MD, of Cincinnati Children's Hospital Medical Center.

But clinicians should still encourage adolescents to voluntarily involve their parents in their decision to seek an abortion, and promote the value of healthy family communication, they noted.

The majority of states require some form of parental involvement in an adolescent's decision to seek an abortion. Of the 38 states with these laws in 2015, according to the AAP, 26 require parental consent (including eight mandating notarized documentation), with 12 requiring notification only.

In an updated policy statement that reaffirmed AAP's position on the subject, Braverman and colleagues wrote that mandatory consent laws can have adverse effects on a patient's health and their psychological well-being. They indicated that the most damaging effect is that these laws "delay and obstruct" a pregnant adolescent's access to timely medical care. In fact, the percentage of second trimester abortions to underage adolescents increased in states such as, Texas, Massachusetts, Mississippi, and Missouri, the authors wrote -- in part because adolescents suspect pregnancy later than adults and partly because mandatory consent laws delay their access to abortion.

The authors also cited negative effects that negative abortion can have on the "emotional health" of mothers, as later-stage abortions have been linked with greater risk of psychological harm. They also cited that the idea of parents protecting their child "from making a decision she might regret later" is largely unfounded, and "ownership" in the decision plays a large role. Most adolescents "express satisfaction with their ultimate pregnancy decisions, provided that they believe the decisions were their own," the authors wrote.

There has also been no link found between abortion and increased risk of mental health problems, with studies in minors showing similar results to recent studies in women.

Judicial bypass, a "reasonable compromise" to parental consent laws offered by some states, poses similar risks to an adolescent's health and psychological well-being, Braverman and colleagues argued. This is where a judge makes the determination about whether an adolescent is "mature enough" to make the decision about an abortion, and whether or not it is in her "best interest" to inform her parents. But the authors cited testimony from judges who preside over these proceedings, saying "unequivocally" the procedure is of no benefit to minors.

The process of judicial bypass also delays the procedure even further, said the authors, and subject adolescents to "extremely burdensome, humiliating, and stressful" court proceedings. Adolescents are often required to divulge private details of their life to a judge with "typically no training in counseling adolescents." Studies have also shown that this may jeopardize an adolescent's ability to receive an abortion.

Braverman and colleagues concluded that the approach most consistent with "ethical, legal, and healthcare" principles is to let the patient decide who should be involved in the decision about her own pregnancy, as well as determining the outcome of the pregnancy for herself.

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